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This week’s update is brought to you by Artis Curiskis, Alice Goldfarb, Erin Kissane, Júlia Ledur, Jessica Malaty Rivera, Kara Oehler, Joanna Pearlstein, Peter Walker, and Nadia Zonis. 

The number of new COVID-19 cases reported by US states and territories surpassed 100,000 Wednesday, an all-time high and a testament to our nation's persistent failure to get the virus under control. New cases rose 20 percent across the country this week. Meanwhile, the number of people hospitalized with COVID-19 shot up 14 percent; more than 52,000 people in the United States were hospitalized as of yesterday. Since last Wednesday, states reported 6,007 deaths from COVID-19, up 8 percent from the previous week.

Counterproductively, testing growth slowed nationally, reaching a total for the week of 8.8 million tests, up about 4 percent from last week’s 8.3 million. The United States is performing about 1.3 million tests each day—a figure that includes an unknown number of antigen tests mixed in with PCR tests.

To put that number in context, recent estimates from a Harvard Global Health Institute analysis found that the US would need to perform up to 14 million tests per day, prioritizing regular screenings of high-risk groups, to reach a “basic level of proactive testing.” The goal of this testing strategy would be to detect outbreaks early in high-risk populations and prevent them from spreading to adjacent communities. (It’s important to note that this estimate relies on both PCR and rapid antigen testing.)

Hospitalizations and deaths rising where cases are up

In the Midwest, detected cases per capita are now well above any other region in any previous period since the pandemic arrived in the United States. As expected, Midwest hospitalizations are rising quickly following the region’s sharply accelerating case surge. Indeed, both cases and hospitalizations are up in every US region, demonstrating that increasing cases continue to be a marker of increasing infections, not just more testing, as we recently explained in detail in this blog post.

Alarmingly, hospitalizations are rising faster as we move deeper into the fall, and they were up particularly sharply over the last week. This acceleration makes sense given what we know about where outbreaks are raging: At the start of the third surge, the worst outbreaks were centered in states with relatively small populations. Those states have posted wrenching per-capita numbers, but haven’t dramatically shifted the national figures. Now the virus is spreading widely in bigger population centers, including Illinois, Michigan, and Pennsylvania, and it’s resurging in Texas, where it was never fully suppressed.

Reported deaths from the Midwest are rising as well, several weeks into that region’s case surge. Notably, the South—the largest US Census region, with nearly double the population of the Midwest—has continued to post substantial COVID-19 death numbers since the summer’s Sunbelt surge, and these deaths are still holding steady.

The chilly Midwest: still a hotspot

In several large midwestern states, outbreaks are still worsening. Cases, hospitalizations, and deaths have continued to climb in Wisconsin, reaching their highest levels to date. The state’s official, internally calculated test positivity rate is over 30 percent, and hospital systems are facing bed and staff shortages. Political and legal wrangling in the state continues, with Wisconsin Gov. Tony Evers’s order to limit the size of indoor gatherings blocked by state courts.

In Illinois, where the rise in cases began about a month later than in Wisconsin, hospitalizations are climbing rapidly, and some hospitals are postponing elective surgeries and expecting staffing shortages. Deaths, too, have begun to rise, but at a more modest rate. In response to the worsening situation, Illinois Gov. J.B. Pritzker has banned indoor service at bars and restaurants across the state.

Elsewhere in the Midwest, Indiana, Kansas, Michigan, Minnesota, and Ohio have all set new single-day records for reported cases of COVID-19 in the past seven days. Across the country, 20 states, including fully half of the 12 states in the Midwest, reported more than 1,000 people currently hospitalized with COVID-19.

Largely rural states in the Mountain West are suffering

In the less populous states where the virus has been spreading unchecked for weeks, the numbers remain high. In Montana, North Dakota, South Dakota, and Wyoming, cases have been increasing since at least mid-September, and hospitalizations and deaths are rising as well. Per-capita hospitalizations in South Dakota are well over the peak we saw over the summer in states like Arizona, with North Dakota not far behind. Per-capita deaths, too, are matching or exceeding those in states with summer highs in Montana, North Dakota, and South Dakota.

Since these states’ populations are small, their outbreaks have less marked effects on national numbers. The virus is spreading quickly in more populous midwestern states, and if the hospitalization and death rates we see in the Dakotas or Montana predict what we will see in those areas, the results will be dire. For comparison, if Illinois were seeing hospitalizations and deaths at the same per-capita rate as South Dakota, there would be twice as many people hospitalized in that state with COVID-19 as there are now, and more than 150 people would be dying there every day.

In Montana, Wyoming, and both Dakotas, disparities in cases and deaths across racial and ethnic communities remain high: In Montana, one in every 18 Indigenous people has tested positive for COVID-19, compared to one in 67 white people. In North Dakota, one in 11 Black people has tested positive for COVID-19, and in South Dakota, the figure is one in 10. White residents of these states, who make up an overwhelming majority of residents, are experiencing less than half as many cases per capita. In Wyoming, the state’s tiny population described in the Census as “Native Hawaiian or Pacific Islander” is seeing one in 11 people test positive, compared to one in 63 white people.

Cases and deaths are spiking in long-term care facilities

Long-term care facility cases continued to rocket upward last week with 19,086 new cases and 1,839 new deaths among staff and residents. More than a quarter of these cases were in just three states: Illinois, Ohio, and Texas. Ohio’s recent surge of cases has been concentrated in nursing homes, and the state accounts for nearly eight percent of the increase in cases in long-term care facilities nationally. Of Ohio’s nursing home cases, 885 are residents and 611 are staff. 

In Wisconsin, long-term care facilities are experiencing intense outbreaks. The state has reported a new high in cases, deaths, and facility outbreaks in our dataset, which goes back to late May. The state reported 112 facilities with a new COVID-19 outbreak in the past week—the largest increase in the nation and nearly double last week’s increase. This means there are 112 communities of vulnerable people in Wisconsin newly at risk, and that efforts to protect these long-term care residents in the face of Wisconsin’s massive outbreak are not working

This week, the United States averaged 260 deaths a day among staff and residents of long-term care facilities. Florida continued to report the highest number of deaths of any state, accounting for 14 percent of all deaths in long-term care facilities nationally. The second highest was Texas, with 8 percent of all deaths

Our long-term care team released new long-term care pages for each US state this week, now including searchable facility-level data. Each state’s data is accessible from our Long-Term Care Tracker main page and from each state’s page in our national dataset. This new release provides the most granular look into the COVID-19’s devastating effects on residents and staff in US long-term care facilities.


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The COVID Tracking Project is a volunteer organization launched from The Atlantic and dedicated to collecting and publishing the data required to understand the COVID-19 outbreak in the United States.

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More Weekly Updates

One Million Cases in Seven Days: This Week in COVID-19 Data, Nov 19

Weekly cases grew 26 percent and nearly 80,000 people in the United States are hospitalized with COVID-19. That’s one-third higher than the nation’s previous record.

A Nationwide Case Surge Hits US Hospitals: This Week in COVID-19 Data, Nov 12

One in 378 US residents tested positive for COVID-19 this week, and hospitalizations have nearly doubled in the past two weeks. The United States is posting new records for cases and hospitalizations nearly every day, and healthcare systems are reaching capacity in many areas where cases have spiked.

By The COVID Tracking ProjectNovember 12, 2020

Third Surge Brings Record-Breaking Case Rates Across the Nation, This Week in COVID-19 Data, Oct 29

Unlike the spring and summer outbreaks, the third surge is geographically dispersed, and counts are up in every region of the country. An increase in testing is not sufficient to explain the numbers.

By The COVID Tracking ProjectOctober 29, 2020